CME Program Registration Form


Updates for Optimizing GU Oncology Cancer Clinics of Excellence
November 9, 2017
12:30 p.m. – 5:30 p.m.
Fairmont Chicago, Millennium Park
Chicago, Illinois

Thank you for your interest in attending the CME Course.
The Online Registration Form is now closed.

To notify us of your interest in registering on-site, please contact
  • Please select the category that best describes your status:*

Specialty:* (Check all that apply)

How did you learn about this conference? (Check all that apply)

Industry Registration
Your submission will need to be approved prior to confirmation of your registration. Approval may be based on current Industry support. To find out if your company is currently supporting LUGPA, please contact JP Baunach in the Industry Relations Department at (847) 264-5942 or by e-mail at

Attendee Information

  • First Name:*
  • Last Name:*
  • Degree(s):
  • Badge First Name:*
  • Title:*
  • Practice Name:*
  • Address 1:*
  • Address 2:
  • City:*
  • State:*
  • ZIP/Postal Code:*
  • Country:*
  • Phone:*
  • FAX:
  • E-mail:*
  • Address Type:*

CME Program Fees

  • Registration Categories
  • Fee
  • Complimentary
  • Complimentary
  • $150


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